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Silicone is Back

By Anthony Youn, MD

Breast augmentation is one of the most popular plastic surgery procedures today. According to the American Society of Plastic Surgeons, in 2005, 291,000 breast augmentations were performed, up from 187,000 just five years ago. The numbers of women undergoing breast augmentation are expected to rise substantially since the FDA lifted the 14-year ban on silicone gel breast implants in November. Breast augmentation is currently the plastic surgery I perform most often in my practice.

Why were silicone breast implants restricted from use with the general public for so long? The FDA placed a moratorium on these implants after numerous women came forward with what were believed to be arthritis and other diseases from gel implants. Subsequent large scale studies have not proven any connection between silicone gel implants and these “connective tissue diseases.” Because of this, the FDA has now allowed the use of silicone gel breast implants in all healthy, non-pregnant women over the age of 22 who desire these implants either for cosmetic improvement or for breast cancer reconstruction.

What’s the difference between gel implants and saline implants? A lot. Prior to November 17, 2006, the U.S. was the only major industrialized country to ban the use of these implants. Gel implants feel and look much more realistic than saline implants. There is no comparison between the two cosmetically.

Gel implants are softer than saline implants, and therefore feel more like real breast tissue. They are also not as prone to develop visible wrinkling which can occur with saline implants in women with a lack of breast tissue. The newest gel implants, like the MemoryGel implants from the Mentor Corporation, are now considered cohesive. This means that the gel which is inside does not leak out of the implant if there is a tear in the shell. It appears to stay in place.

While this provides the patient with some peace-of-mind, it is important to realize that the FDA recommends an MRI be performed three years after the implantation, and every two years thereafter to make sure there are no tears in the implant’s shell.

While most plastic surgeons and thousands of patients are applauding the FDA’s decision to approve silicone breast implants, many women continue to undergo breast augmentation using saline implants. Although not as realistic as gel implants, saline implants have been used nearly exclusively for the past fourteen years, with overall pleasing results. These implants are less expensive than gel implants (almost half the cost!), have a safety profile second-to-none, and require a smaller incision for placement.

Unlike gel implants, saline implants can be placed via the Transaxillary Endoscopic Breast Augmentation technique for the most hidden scar. Gel implants must be placed through either an incision under the breast or around the areola. In my practice, I’m finding that 2 out of every 3 women who undergo breast augmentation surgery are continuing to choose saline breast implants. Nearly all are extremely happy with their choice.

So where does this leave the patient who is unsure of which implant to use for breast augmentation? The best thing about the availability of gel implants is that women now have a choice on which implants to use. It is important to discuss this choice with your plastic surgeon to determine just which implant is right for you. Make sure to choose a plastic surgeon who is certified by the American Board of Plastic Surgery and has hospital privileges to perform breast augmentation. This way you know your plastic surgeon has been fully trained to perform the surgery you are considering, and hasn’t just completed a weekend course on the procedure. Look at the surgeon’s before-and-after photos, ask questions, and avoid “bargain-basement” cosmetic surgery centers which often hire poorly trained physicians. In plastic surgery as well as life, you often get what you pay for.

Dr. Anthony Youn is a nationally recognized, board-certified plastic surgeon and is a member of the American Society of Plastic Surgeons. He received his medical degree from Michigan State University in 1998 and completed his general surgery and plastic surgery training at the Grand Rapids MERC Plastic Surgery Residency Program. He also completed a fellowship with the Advanced Aesthetic Surgery Fellowship in Beverly Hills, California. He has privileges at William Beaumont Hospital in Troy and Unasource Surgery Center. He’s been featured on E!’s “Dr. 90210”.